Penetrating Keratoplasty for Varicella-Zoster Virus Keratopathy

Abstract

Although varicella-zoster virus keratopathy is an uncommon indication for penetrating keratoplasty, effective visual rehabilitation can be achieved in these patients. Careful postoperative management, frequent lubrication, and lateral tarsorrhaphies to protect the corneal surface are major factors in the successful outcome of these cases.

Elliptical Nonmechanical Corneal Trephination

“…Such irreversible reactions caused by recurrent neurotrophic varicella-zoster virus keratopathy have been reported previously in the literature. 21 It was our clinical impression that the incidence of immunologic graft reaction was reduced in elliptical transplantation taking into account the patients' corneal size for choosing the actual mask size. In ;17% of cases, smaller than the ''standard'' size of 7.0 3 8.0 mm was chosen because of a smaller host cornea.…”

Boston Keratoprosthesis Type 1 for Herpes Simplex and Herpes Zoster Keratopathy

“…[1][2][3][4] Traditionally, rehabilitation of herpetic corneal visual loss with penetrating keratoplasty (PKP) has been associated with a poor prognosis for graft survival and visual outcome in eyes with a history of herpes simplex virus (HSV) or herpes zoster virus (HZV). [1][2][3][4] Factors contributing to unfavorable PKP outcomes included recurrent herpetic keratouveitis, neurotrophic complications (epitheliopathy, recurrent erosions, persistent epithelial defects, sterile corneal ulceration, or secondary microbial keratitis), iatrogenic ocular surface complications related to topical antiviral treatment and prophylaxis, glaucoma escalation, and immune-mediate endothelial rejection. [1][2][3][4] The introduction of systemic antiviral therapy dramatically reduced the incidence of recurrent herpetic keratouveitis after keratoplasty, as well as iatrogenic complications related to chronic use of prophylactic topical antiviral therapy.…”

“…[1][2][3][4] Factors contributing to unfavorable PKP outcomes included recurrent herpetic keratouveitis, neurotrophic complications (epitheliopathy, recurrent erosions, persistent epithelial defects, sterile corneal ulceration, or secondary microbial keratitis), iatrogenic ocular surface complications related to topical antiviral treatment and prophylaxis, glaucoma escalation, and immune-mediate endothelial rejection. [1][2][3][4] The introduction of systemic antiviral therapy dramatically reduced the incidence of recurrent herpetic keratouveitis after keratoplasty, as well as iatrogenic complications related to chronic use of prophylactic topical antiviral therapy. 4 This resulted in an improvement in the PKP prognosis in eyes with HSV, but not in those with HZV keratopathy, presumably because of the greater neurotrophic deficit and related complications associated with the latter condition.…”

“…4 This resulted in an improvement in the PKP prognosis in eyes with HSV, but not in those with HZV keratopathy, presumably because of the greater neurotrophic deficit and related complications associated with the latter condition. 1,2 Boston keratoprosthesis type 1 (Kpro-1) offers an alternative to traditional keratoplasty in eyes with a poor prognosis for primary or repeat keratoplasty. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Herpetic keratopathy seems to occupy an intermediate Kpro-1 prognostic category below the more favorable category of noninflammatory indications (eg, failed grafts that had been performed for corneal edema, keratoconus, dystrophies, or degeneration) and above the less favorable categories of inflammatory conditions (eg, chemical injury) or cicatricial autoimmune disorders (eg, ocular cicatricial pemphigoid, Stevens-Johnson syndrome).…”

Morphofunktionelle Untersuchungen der Wirksamkeit der Keratoplastik bei der Behandlung von Keratomykosen

“…Aus einigen Literaturquellen geht hervor, dass Pilzkeratitiden am häufigsten in Ländern wie Indien, Bangladesch, Nepal, Ghana, Singapur und China vorkommen [3,[7][8][9][10] sowie auch im US-Bundesstaat Florida [5]. Andere Risikofaktoren für eine Keratomykose können außer Mikrotraumen auch eine langfristige Anwendung von lokal angewandten Antibiotika und Kortikosteroiden sein sowie einige systemische Erkrankungen [11]. Pilzinfektionen der Hornhaut entwickeln sich oft in der landwirtschaftlich arbeitenden Bevölke-rung, bei Jugendlichen sowie Langzeit-Kontaktlinsenträgern [5,8].…”